Low Anterior Resection (LAR)

Procedure Snapshot

• Indication: Mid-rectal cancer with distal margin > 1 cm above sphincters.
• Expected duration: ___
• Special instruments: Curved stapler, TME kit, energy device, pelvic retractor.

Step Workflow — Open or Lap

1. Mobilize sigmoid and rectum (TME plane down to levator ani).
2. Identify ureters and hypogastric nerves.
3. Divide IMA and IMV.
4. Transect rectum with stapler; perform circular-stapled colorectal anastomosis.
5. Test air leak and place drain. Diverting loop ileostomy optional.

Key Pimp Questions

• Q: What is TME? A: Sharp dissection of mesorectal fascia en bloc for local control (PMID 30764073).
• Q: Anastomotic leak rate? ___ (PMID 30981656).

Critical Anatomy

• Landmarks: Mesorectal fascia, hypogastric nerves, levator ani.
• Danger zones: Presacral plexus bleeding.

Informed Consent Highlights

• Risks: Leak, bleeding, urinary/sexual dysfunction.

Post-op Considerations

• Foley until POD 3–5; ERAS mobilization; ostomy teaching.

References

• Chassin’s, Rectum chapter; Clinical Scenarios, Colorectal.
• Heald 1982; Hasegawa 2019 (PMID 30764073).